Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (39 page)

Rider was a tenacious worker who loved her job just north of the Louisiana state capitol complex, where a fraud investigator could work
surrounded by reminders of the unbroken strain of patronage running through Louisiana political history. Legendary governor Huey P. Long, known as “Kingfish,” both convinced legislators to build the limestone and marble capitol during the Depression and was assassinated there in 1935. Thirty-four stories high and Art Deco in its details, it remained the nation’s tallest state capitol. Both Rider and Schafer lived about an hour away from Baton Rouge and made the drive to work in state-issued Impalas. Rider kept an ancient blue Thunderbird at home.

Rider was twenty-four years younger and a foot shorter than Schafer. He was newer to the unit and had had only one previous interaction with her, a year earlier, when she led an investigation of combined money laundering and Medicaid fraud and came to testify at trial. She had dimples when she smiled, but she cultivated the conservative look of someone dedicated to a life behind the scenes, with a medium build, gray-blue eyes, and natural hair she called dishwater blond. It was the first time she had ever been called before a jury, and she was nervous about going onstage. Schafer, by contrast, was a frustrated actor who loved the sanctioned confrontation of the courtroom; it was practically the reason he had gone to law school. He’d advised Rider to hold on to a pen in her lap and fidget with it to avoid telegraphing insecurity to the jury. She did well, and Schafer saw that Rider worked hard because she believed in what she did, not out of a desire to get out in front of others and be recognized for it.

Upon receiving the fax from LifeCare, Rider immediately requested copies of the patients’ medical records from Tenet, which controlled access to Memorial, where the records were still likely to be. Tenet officials were vague about the location of the records. They might have been removed with the bodies to the coroner’s office or might still be in the hospital. Rider, Schafer, and several colleagues drove to New Orleans with subpoenas to attempt to retrieve them. Security guards denied them entry to the hospital, insisting they needed protective gear. Federal
investigators accompanying the group located two hazardous-materials suits and went into Memorial, but found little in the way of records for the nine patients.

Butch Schafer had visited many hospitals in his life. He had never heard of one that lacked current records. That struck him as curious. Interesting, too, was the presence of heavily armed guards intent on blocking the group.

The number of complaints arriving at the attorney general’s office about other hospitals and nursing homes was also surprising. The CEO of Touro Infirmary in New Orleans, Les Hirsch, bragged after the storm about his hospital’s performance.
In an essay for
Modern Healthcare
, he wrote that even after a fire department superintendent gave Touro’s staff an hour to leave the hospital because violence was breaking out in the city, there was “no way” they would leave patients behind. His employees stayed until the last patient was safely evacuated.

An anonymous letter writer took issue with Hirsch’s story and copied the attorney general. A patient at Touro had been found “alive and abandoned” on Friday, September 2, 2005, by workers from a nearby hospital.

One of the nurses helping with the hospital evacuation came upon 16 bodies in your building. It was reported that numerous morphine vials were found littering the floor. One of these bodies was still alive and is currently receiving treatment in another hospital. Why were these patients left to die? Were they euthanized? How did you decide which ones to leave, based it on ability to pay? I find the actions of this hospital deplorable. No patient should be left to die or euthanized.

“Someday,” the letter writer warned, “the truth will be told.”

MEMORIAL PATHOLOGIST Dr. John Skinner had recorded the names, birth dates, and locations of the dead before leaving Memorial. He had faxed the handwritten scraps of paper to Tenet officials in Texas, who entrusted them to the company’s regional chief medical officer, the man who had worked from vacation in Oregon as the disaster unfolded. During the week and a half that the bodies of the dead remained in the hospital and were not yet in the hands of the coroner, little was done with this information. Tenet telephone operators took down messages from dozens of frantic families, and these were entered into a database. If a patient’s relatives somehow reached the medical officer directly, he told them what he knew. Not until after the bodies were retrieved and the attorney general’s office launched an investigation did Tenet officials print out medical chart “face sheets” with names, addresses, and family contacts of the dead, and assign various employees to notify them. The callers received a set of instructions:

     1. Speak in general terms.

     2. Never give opinions!

     3. May be first time family has had contact with anyone about loved one.

     4. The loved ones know nothing except news media information.

     5. Loved ones are usually angry.

     6. Tell truth, i.e., Patient may have died due to lack of electricity or high temperatures, etc.

The employee was to introduce himself or herself, verify the family member’s relationship with the patient, and: “Reveal information: patient expired between the hurricane and evacuation of patients from the facility.”

The document included guidance for handling tough questions, including why notification was occurring more than two weeks after the
deaths: “All information electronic; however, computer server stored in New Orleans. Did not ever plan for a whole city to shut down.”

The employee was to tell each family: “Your loved one was cared for throughout. Your loved one was identified and shrouded and placed in our chapel area. Your loved one was treated with dignity.”

If a family member questioned the decision not to evacuate before the hurricane, it was based on “risk to the patient.” The decision to evacuate after Katrina had been mandated by government officials: “In situations like this disaster, the government takes control. The state retrieved your loved one and brought to the parish’s coroner office. Eventually, all deceased will be taken to St. Gabriel, LA (southwest of Baton Rouge), where a thorough medical exam will be performed and a cause of death will be identified. A death certificate will be available. Once a cause of death has been determined, state officials will contact the family.”

The eight members of the call team included ICU nurse manager Karen Wynn and incident commander Susan Mulderick. Both women had spent the night of Thursday, September 1, on Memorial’s open helipad with about fifty other staff and family members, including Mulderick’s aged mother, still wearing her housedress. Rescue helicopters had stopped coming after dark, and the group did not reenter the hospital for fear of encountering looters. Armed staff members blockaded the staircases. When a group of people appeared at a hospital window, including wide-eyed children, the armed employees threatened to shoot “the looters” if they came closer.

The next morning, Wynn flew out on a helicopter to the New Orleans airport. It angered and disheartened her to see Mr. Rodney Scott sitting on the concourse in his wheelchair, shivering in a paper gown, without a soul taking care of him. Many of the last push of Memorial patients from the previous evening had not gone far after leaving the hospital. Her injured ICU nurse, however, had been flown directly to a Baton Rouge hospital at the insistence of Dr. Roy Culotta and another
accompanying doctor, with a Coast Guard pilot’s knife at the ready for one of them to extemporize the insertion of a chest tube. Fortunately it was not necessary, and X-rays showed the nurse had sustained only severe bruises to his ribs and the area around his spleen. He spent three nights at the hospital being treated for dehydration developed over days of moving patients in the heat.

Susan Mulderick’s harrowing hegira from Memorial had ended in the state of Delaware and included a day at a crowded refugee-collection point at the small New Orleans Lakefront Airport. She and her exhausted colleagues had been asked to care for people there. A sympathetic official ushered them to an airplane ahead of others who had waited longer, and they feared for their lives that the desperate mob would attack them to avoid being left behind. By contrast, a few of the hospital’s executives, she later learned, had been helicoptered to a nearby Tenet hospital and given a hot meal and a room to shower, shave, and change before being picked up in a helicopter and taken to Hattiesburg, Mississippi, then flown in a private jet to their preferred destinations. Memorial CFO Curtis Dosch, a beneficiary of this arrangement, had learned of it from Tenet’s Bob Smith by phone on Thursday. Dosch’s wife had spent the week making repeated calls to Tenet’s COO, a longtime friend, asking when Tenet would get Dosch out of there and insisting that he not go by ground. “You can’t put my husband on a bus with all them people” was how Dosch phrased it when he told the story.

In fact, the buses leased by Tenet weren’t bad. They drove to Dallas, where the company had reserved and paid for rooms at the upscale Anatole Hotel, complete with toiletry amenity packs, free food vouchers, and assistance reuniting with loves ones. Memorial staff, family members, and even LifeCare employees lucky enough to be rescued via Tenet-hired helicopters and taken to the nearby Tenet hospital also received meals and showers there and could take advantage of the arrangement.

Mulderick called her assigned sets of family numbers for three of the
deceased patients repeatedly, reaching full voice-mail boxes and automated recordings announcing network difficulties. After several hours, she made contact with the son and daughter-in-law of one elderly LifeCare patient. Mulderick tried to give context to their mother’s death. Water never reached the patient-care areas, but the basement flooded and there was no electricity or air-conditioning. The woman had been cared for by MDs and nurses, but was very ill.

The following Monday, September 19, Mulderick received a call from Dr. Anna Pou. Pou had read that the state was investigating the deaths at Memorial. CNN reporters had phoned her to say they were preparing a report on possible euthanasia at the hospital, and they pressed her to tell her side of the story. She didn’t know what to do. She asked Mulderick for help. Mulderick told her to sit tight and someone from Tenet would call her.

ANNA POU had climbed into a helicopter on Memorial’s helipad around six p.m. on Thursday, several hours before the last patients were airlifted. She looked down, disoriented by the water covering familiar landmarks, and felt heartbroken for her city. Pou’s New Orleans home on high ground near the river had been spared from flooding. Less than a week after leaving Memorial, with the hospitals still closed and patients displaced, she had agreed to work for her employer, LSU, at a public hospital in Baton Rouge.

With several hospital workers extremely upset about the patient injections and the many deaths, word quickly made it to reporters. When CNN and other media contacted Pou, she reached out first to fellow Memorial doctors. She phoned chief medical officer Ewing Cook, the pulmonologist whom Susan Mulderick had asked to advise Pou about what drugs to give the patients. He was in Houston after the disaster, and she told him that people in Louisiana were looking into things. She asked
if he had been contacted. He had, by the news media. CNN was looking for him, too. He wanted nothing of it. He wished to remain completely unknown. When it came to issues of medical ethics and helping people die—good Gertie, there were people with opinions all over the place! “Anna,” he said, “don’t talk to the news media. Say nothing.” A reporter looking for sensationalism could twist their words in any way. “Hide,” he advised.

Pou also called John Walsh, Memorial’s surgery department chair, a smart and kindhearted general surgeon whom she had come to know when they chatted during breaks between operations in the year she had worked at the hospital. On the afternoon of Thursday, September 1, she had stopped to speak with him about what happened on the seventh floor, where she had injected patients and many there had died. Walsh now urged Pou to get an attorney, be forthcoming, and contact Memorial CEO René Goux.
She left messages on Goux’s cell phone and with his mother. When she couldn’t reach him, she called Mulderick and asked for help.